Anti-NMDA receptor encephalitis: A clinical case report

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BSTRACT

Anti-NMDA receptor encephalitis (ANRE) is an autoimmune encephalitis that often begins with a viral-like prodrome and progresses to prominent psychiatric changes, movement abnormalities, and autonomic instability, making early diagnosis challenging. We present a case of a previously healthy 21-year-old female who developed acute altered mental status, paranoia, and orolingual dyskinesias following 2 weeks of flu-like symptoms. Initial laboratory studies, MRI, and EEG were nondiagnostic. Due to concern for ANRE, immunotherapy with steroids and IVIG was initiated, and transvaginal ultrasound identified an ovarian teratoma, which was subsequently removed. cerebrospinal fluid testing later confirmed anti-NMDA receptor antibodies. Despite appropriate first- and second-line therapy, the patient experienced prolonged neurologic deficits requiring long-term care for several months. However, by 24 months, she demonstrated complete neurologic recovery. This case highlights the importance of early recognition, broad diagnostic evaluation, and continued long-term management as meaningful recovery with ANRE may occur even after protracted illness. Furthermore, this case highlights the potential of healthcare worker biases that may arise alongside these diagnostic challenges.